Minimally invasive technique represented by laparoscopic surgery is one of the developing directions of surgery in the 21st century. It combines modern advanced science and technology with modern medicine. It is a combination of traditional surgery technology and modern electronic information, light guide technology and various energy conduction. Laparoscopic surgery has been widely used because of its advantages such as less trauma, less pain, quick recovery and less scar. The disinfection and maintenance of laparoscopic surgical instruments by using laparoscopic disinfection box is a much discussed problem in the operating room.

Methods of disinfection and sterilization of laparoscopic surgical instruments

Effective disinfection and sterilization is very important to prevent and control nosocomial infection. According to the requirements of "Nosocomial Infection Management Practice", the best sterilization method of laparoscopy is ethylene oxide or autoclaves, while high level disinfection method is commonly used in clinical practice.

1.1 Disinfection and sterilization of lenses: due to the high cost of ethylene oxide sterilization (the cost is about 1000 yuan per time) and the long time (more than 6 ~ 12h), the limited number of lenses in clinical practice and the large number of patients who receive surgery, it is difficult to use. And because the lens is a high-precision and expensive instrument, there are very few lenses that can withstand autoclave, so the autoclave method can not be popularized. Some data suggest that laparoscopy can do a high level of disinfection, FDA has approved a 2.4% glutaraldehyde at 250C in the stainless steel disinfection box immersed in 45 minutes can reach high efficiency disinfection; APIC recommends that 2% glutaraldehyde soaked in 200C for 20 minutes can achieve efficient disinfection [3]. In some hospitals in Singapore, endoscopes for in-table surgery are placed in sterilizing boxes for 30 minutes using Sterile II machines. Domestic hospitals mostly use 40% formaldehyde (80ml/m2) plus potassium permanganate powder fumigation for 3h or 2% glutaraldehyde immersion to replace the sterilization of laparoscopic treatment.

1.1 Disinfection and sterilization of laparoscopic surgical instruments. Laparoscopic surgical instruments are disposable and recyclable, high-temperature and high-temperature resistant. Therefore, the property of each device should be considered when selecting the sterilization method. All instruments should be cleaned with disinfection box before sterilization (cleaning method is described later).

1.2.1 Sterilization and disinfection methods of high-temperature laparoscopic instruments: the endoscopic instruments can be directly packaged into the endoscopic instrument disinfection box for autoclave sterilization; Open the valves and joints of the instruments to avoid overlap and keep the lumen unobtrusive. Put them into the 40% formaldehyde disinfection box and disinfect for more than 12 hours. The instruments for urgent use can be placed in a disinfection box together with the lens and soaked in 2% glutaraldehyde for 20 minutes. Pay attention to open all valves and joints. If there is a cavity, fill the cavity with disinfectant with a syringe to make the instruments fully contact with the disinfectant. At present, our hospital uses the "Huiri" Waywin -2000 endoscopic sterilizer, and the special sterilizing box is peroxyacetic acid powder, which can meet the requirements of sterilization after 30 minutes.

1.2.2 Disinfection and sterilization method of laparoscopic instruments with high temperature tolerance: autoclaving method should not be used for laparoscopic instruments with high temperature tolerance to avoid damage. The above high level immersion disinfection, endoscopic sterilizer or ethylene oxide disinfection methods can be used.

Cleaning and maintenance of laparoscopic surgical instruments

2.1 Cleaning the most valuable and vulnerable equipment accessories, such as lens, optical cable, camera and so on, should be especially careful and prudent. After cleaning with a wet cloth, wipe with 75% alcohol and dry with a soft dry cloth. Devices that penetrate the skin or mucous membranes to enter sterile tissue must be thoroughly cleaned before sterilization in disinfecting boxes. Postoperative devices should be cleaned immediately in a disinfectant box -- rinsed with running water rather than pretreated with disinfectant, which can cause organic matter to solidify and make cleaning more difficult. Then use 1:2000 3M Ambien for quick multi-enzyme cleaning and soaking for 5-10 minutes at a temperature of 30-400C. If using ultrasonic scrubber, soak for 2 minutes. If the contamination is heavy or the residue is dry, the soaking time should be extended. After soaking, tap water, deionized water or distilled water should be used together with a disinfected brush, high-pressure water gun and other tools to thoroughly rinse and remove the residual debris and residual enzymes on the equipment. Complicated items must be cleaned or dismantled by hand, pay attention to prevent the loss of accessories.

2.2 Maintenance and Maintenance of Laparoscopic Instruments Optical cable and camera cable should not be twisted into angles, but should be coiled with a diameter of 15cm and stored in a fixed cabinet. Because of the long-term use of chemical disinfection of optical cable and camera line damage, so the surgery had better be covered with disposable disinfection mirror cover. The instruments for laparoscopic surgery were soaked with 1:125 rust removers for 15 minutes every month to remove the rust in the instruments and prolong the service life of the instruments. Apply silicone free lubricant to the joint, valve, valve and spring of the instrument every two weeks to facilitate flexible operation of the instrument and close the tip.

All instruments and accessories must be placed in a disinfectant box to dry thoroughly before storage to remove residual moisture. Dry the outer surface with a soft absorbent towel/cloth and use compressed gas or 95% alcohol inside the lumen to help complete the drying process.

Through the comparative study of different endoscopic disinfection and maintenance methods, we found that under the current domestic economic and technical constraints, the endoscopic sterilizer with peracetic acid medicine box currently used in our hospital can not only meet the strict requirements for the disinfection of endoscopic instruments in surgery, but also has the following sterilization methods: It has the advantages of rapid disinfection, low corrosiveness to high precision and expensive instruments such as endoscope, and no obvious toxic and side effects on human body, so it has significant advantages. In addition, through inter-hospital communication and literature search, our hospital is at the leading level in endoscopic disinfection and maintenance in China.